Healthcare Provider Details

I. General information

NPI: 1043213358
Provider Name (Legal Business Name): MRS HOMECARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2005
Last Update Date: 05/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2467A S MAIN ST
MOULTRIE GA
31768-6531
US

IV. Provider business mailing address

PO BOX 568
ALBANY GA
31702-0568
US

V. Phone/Fax

Practice location:
  • Phone: 229-890-6949
  • Fax: 229-890-7386
Mailing address:
  • Phone: 229-439-2403
  • Fax: 229-883-8426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: MR. E. THOMAS RIDDLE
Title or Position: PRESIDENT
Credential:
Phone: 229-439-2403